COMMUNITY BRIDGES, INC (GLOBE STABILIZATION AND RECOVERY UNIT) - NPI NUMBER 1093960304

Summary

Provider Name: COMMUNITY BRIDGES, INC (GLOBE STABILIZATION AND RECOVERY UNIT)

NPI Number: 1093960304

Clasification: Case Management (251B00000X)

Address:
5734 EAST HOPE DRIVE
GLOBE, AZ
ZIP 85501

Phone Number: (928) 425-2415



Detailed Information

COMMUNITY BRIDGES, INC is a case management in Globe, AZ. The provider is an organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. The assigned NPI number for this provider is 1093960304 and is registered as an organization entity type.
The provider Is Doing Business As Globe Stabilization And Recovery Unit.

The provider's business address is:

5734 EAST HOPE DRIVE
GLOBE, AZ
ZIP 85501
Phone: (928) 425-2415
Fax: (928) 425-2464

The provider's authorized official is John F Hogeboom .
The authorized official title is Vp/coo and has the following contact phone number (480) 831-7566.

The enumeration date for this NPI number is 12/1/2008 and was last updated on 1/26/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251B00000X Case Management BH-3246 AZ Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 Z145164 OTHER AZ MEDICARE PTAN
2 388723 MEDICAID AZ

NPI Record

No. Field Name Field Value
1 NPI 1093960304
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name COMMUNITY BRIDGES, INC
5 Provider Other Organization Name GLOBE STABILIZATION AND RECOVERY UNIT
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 5734 EAST HOPE DRIVE
8 Provider Business Practice Location Address City Name GLOBE
9 Provider Business Practice Location Address State Name AZ
10 Provider Business Practice Location Address Postal Code 85501
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 9284252415
13 Provider Business Practice Location Address Fax Number 9284252464
14 Provider Enumeration Date 12/1/2008
15 Last Update Date 1/26/2012
16 Authorized Official Last Name HOGEBOOM
17 Authorized Official First Name JOHN
18 Authorized Official Middle Name F
19 Authorized Official Title or Position VP/COO
20 Authorized Official Telephone Number 4808317566
21 Healthcare Provider Taxonomy Code 1 251B00000X
22 Provider License Number 1 BH-3246
23 Provider License Number State Code 1 AZ
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 Z145164
26 Other Provider Identifier Type Code 1 01
27 Other Provider Identifier State 1 AZ
28 Other Provider Identifier Issuer 1 MEDICARE PTAN
29 Other Provider Identifier 2 388723
30 Other Provider Identifier Type Code 2 05
31 Other Provider Identifier State 2 AZ
32 Is Organization Subpart Y
33 Parent Organization LBN COMMUNITY BRIDGES, INC
34 Parent Organization TIN
35 Authorized Official Name Prefix Text MR.
36 Authorized Official Credential Text LISAC

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This page was last updated on: 7/15/2014
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